Provider Demographics
NPI:1831147073
Name:ALT, WALTER J (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:ALT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EAST MAIN STREET
Mailing Address - Street 2:LAHEY MERRIMAC
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860
Mailing Address - Country:US
Mailing Address - Phone:978-346-9733
Mailing Address - Fax:
Practice Address - Street 1:5 EAST MAIN STREET
Practice Address - Street 2:LAHEY MERRIMAC
Practice Address - City:MERRIMAC
Practice Address - State:MA
Practice Address - Zip Code:01860
Practice Address - Country:US
Practice Address - Phone:978-346-9733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110056507AMedicaid
MA110056507AMedicaid